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目的探讨替比夫定(LDT)对控制妊娠合并慢性乙型肝炎病毒(HBV)感染引起的各型肝病活动和阻断HBV母婴传播的疗效及安全性。方法对47例ALT≥2×ULN,HBeAg阳性,HBV DNA≥1×105拷贝/毫升的慢性HBV感染孕妇(42例慢性乙型肝炎、2例慢性重型乙肝、3例乙肝肝硬化),于妊娠早期(12例)、中期(7例)、晚期(28例)在护肝对症治疗的基础上服用LDT,600mg,1次/天,新生儿出生后常规注射高效价乙肝免疫球蛋白和重组酵母乙型肝炎疫苗。观察分娩前后病毒学及生化学应答率、母婴并发症发生率、HBV母婴阻断率、婴幼儿发育情况及药物不良反应。结果 47例接受LDT治疗的慢性HBV感染孕妇,分娩前HBV DNA检测不到率、HBeAg转阴率分别为89.4%和17.0%,ALT复常率为87.2%;母婴并发症发生率低;所有新生儿7个月时检测HBsAg、HBeAg均阴性,并可测得抗-HBs,HBV母婴阻断率达100%;对新生儿经7个月以上随访,均发育正常;母亲分娩后继续治疗,病情稳定。结论 LDT能快速降低慢性HBV感染孕妇的HBV DNA水平,有效地控制肝炎活动、阻断HBV母婴传播,未见婴幼儿发育异常及药物不良反应。
Objective To investigate the efficacy and safety of telbivudine (LDT) in controlling various liver diseases and blocking the transmission of HBV from mother to mother in pregnancy complicated with chronic hepatitis B virus infection. Methods Forty-seven pregnant women with chronic HBV infection (42 chronic hepatitis B, 2 chronic severe hepatitis B and 3 hepatitis B cirrhosis) with ALT≥2 × ULN, HBeAg positive and HBV DNA≥1 × 105 copies / In the early stage (12 cases), the middle stage (7 cases) and the late stage (28 cases) were treated with LDT on the basis of symptomatic treatment of liver disease. The newborns were injected with high titer hepatitis B immunoglobulin and recombinant yeast Hepatitis B vaccine. Virological and biochemical response rates before and after childbirth, the incidence of maternal and neonatal complications, the rate of HBV maternal and neonatal blockage, infant development and adverse drug reactions were observed. Results In 47 pregnant women with chronic HBV infection who received LDT, the undetectable HBV DNA before delivery was 89.4% and 17.0% respectively, and the ALT normalization rate was 87.2%. The incidence of maternal and infant complications was low. All Neonates detected HBsAg and HBeAg at 7 months, and measurable anti-HBs, the rate of blocking mother-infant HBV was 100%; normal newborns were followed up for more than 7 months; the mother continued treatment after childbirth ,Stable condition. Conclusions LDT can rapidly reduce the level of HBV DNA in pregnant women with chronic HBV infection, effectively control the hepatitis activity, and prevent the transmission of HBV from mother to infant. No abnormal development in infants and young children and adverse drug reactions are observed.